Comparing the effects of endometrial injury with hysteroscopy or Pipelle cannula on fertility outcome.

OBJECTIVE

To compare the effects of mechanical endometrial injury performed with hysteroscopy or Pipelle cannula on fertility outcome in patients with implantation failure.

PATIENTS AND METHODS

Sixty patients with a history of two or more failed ICSI despite the transfer of high-quality embryos were equally divided into three groups: Group A - injury with hysteroscopy (n=20), Group B - injury with Pipelle cannula (n=20), Group C - no injury (n=20). Patients in group A underwent endometrial injury with monopolar needle forceps between days 10-12 of the proliferative phase in the preceding cycle before ovarian stimulation. Patients in group B underwent endometrial injury with Pipelle cannula between days 22-24 of the mid-luteal phase in the preceding cycle. Patients in group C had no injuries. Beta-hCG, clinical pregnancy, live birth and miscarriage rates were analyzed among the groups.

RESULTS

There were no significant differences in terms of positive pregnancy test, clinical pregnancy and live birth rates between hysteroscopy and Pipelle groups. Compared to the control group, both clinical pregnancy and live birth rates were found to be significantly higher in patients who underwent endometrial injury with hysteroscopy or Pipelle cannula. Miscarriage rates in the control group were significantly higher than those in the Pipella or hysteroscopic injury.

CONCLUSIONS

Endometrial injuries performed in the follicular phase with hysteroscopic monopolar forceps or in the secretory phase with Pipelle cannula increase pregnancy and live birth.